When a patient dies, take a pause

A young woman is brought to the emergency room after being hit by a sports utility vehicle. After 45 minutes of resuscitation, she is pronounced dead. Jonathan Bartels, RN, recalled the case and the vacancy he felt afterwards. It prompted him to develop "The Pause"—taking a few moments after the patient has died, to acknowledge their passing and the efforts of the healthcare team.

Bartels explains that he introduced the pause into the emergency department at the University of Virginia Health System in 2009 “to be together and present in a singular moment of grief and loss. I would ask each to, in their own way, offer silent recognition of the lost human life—someone’s mother, father, sibling, or child—to remember that the person who had died loved and was loved, to understand that the person’s passing deserved recognition, and to acknowledge that our own efforts, too, were worthy of honor." He elaborates further in his introduction video (below - produced by Stephen Brannon).

Bartels adds: “The pause slows our racing minds, offering mental space so that we are not drawn into the vortex of failure versus success. We bear witness to a reality devoid of projections. We give ourselves the opportunity to forgive—and be forgiven. This practice removes the impotence that colors loss in health care. It empowers each individual to offer support without imposing beliefs on others. It is both communal and individual, and it allows for secular, religious, and humanistic perspectives. It is simplicity infused with complexity. We are called to bear witness to the reality of loss and the acceptance of reality.”

The pause can also help families. Bartels tweeted that “ when families see you stand and silently honor...it helps them too.”

It also helps families heal. It was not my original intent, but when families see you stand and silently honor...it helps them too.

Cleveland Clinic, in the USA, introduced “The Pause”. After a patient death, the team gathers at the bedside for a 15-30 second silence. “The purpose is to honour the human life and the efforts of the team”, writes Silvia Perez Protto, MD.

The suggested script is:

“Let us take a moment to pause and honor (patient’s name or this person). He/she was someone who loved and was loved; was someone’s family member and friend. In our own way and in silence let us take a moment to honor (patient’s name). Let us also honor and recognize the care provided by our team.”

Siliva Perez-Prottoe, Medical director of End of Life Programs at Cleveland Clinic explained in a tweet that if the family is there they ask for permission. “If they prefer us not to do it, we gather at other location, usually at the nurses room.”

Providence Health Care has also introduced the practice, and provides instructions:

One person in the room (the Pause can be initiated by anyone in the room) simply says something like, "Let's take a pause to honor the passing of this patient, who was someone's brother (father, mother, son, partner, parent, etc.)."

In addition, caregivers recognize their own contribution with a statement, such as, "We all worked to provide the best care possible for this patient and should acknowledge that care."

Lastly, everyone simply stands silently at the bedside for 30 seconds or so before going to care for other patients. The Pause is not mandatory but it is an example of the Providence promise to answer the call of every person we serve to "Know me, Care for me, Ease my way."

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